Department of Radiology, Oncology and Radiation Sciences, Section of Radiology, Uppsala University Hospital, Uppsala, Sweden.
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden.
Eur J Vasc Endovasc Surg. 2014 Sep;48(3):325-9. doi: 10.1016/j.ejvs.2014.05.013. Epub 2014 Jun 21.
In patients with peripheral arterial occlusive disease, renal impairment is a common contraindication to iodine and gadolinium contrast media, which limits the utility of conventional computed tomography angiography (CTA) and magnetic resonance angiography (MRA). It is proposed that selective intra-arterial dual-energy CT-angiography (s-CTA), that is CTA with intra-arterial injection of an ultra-low dose iodine contrast media, is a feasible, safe and accurate alternative imaging method to conventional non-invasive contrast enhanced vascular imaging in this patient group. The aim of this study was to report a preliminary experience of s-CTA in patients with critical limb ischemia and renal insufficiency with respect to safety, feasibility, and diagnostic accuracy.
Ten non-consecutive patients with ischemic foot ulcers underwent s-CTA of one leg. Procedure related complications were recorded and imaging results were compared with conventional digital subtraction angiography (DSA).
A median 17 mL (range 10-19 mL) contrast media (400 mg I/mL) was used. The median baseline plasma creatinine was 163 μmol/L (range 105-569) pre s-CTA versus 153 μmol/L (range 105-562) post s-CTA (p = .24). There was no puncture site complication. Among the patients selected for intervention (n = 6 with 30 arterial segments) the s-CTA findings correlated well with the DSA findings; the diagnostic sensitivity was 100%, the specificity 89%, and the accuracy 93%.
In this pilot study, a novel imaging method (s-CTA) is presented that provides high-quality arterial phase images with ultra-low dose iodine contrast media useful also for patients unsuitable for conventional contrast enhanced imaging methods because of renal insufficiency.
在患有外周动脉阻塞性疾病的患者中，肾功能损害是碘和钆造影剂的常见禁忌证，这限制了常规计算机断层血管造影（CTA）和磁共振血管造影（MRA）的应用。有人提出，选择性动脉内双能量 CT 血管造影（s-CTA），即经动脉内注射超低剂量碘造影剂的 CTA，是一种可行、安全且准确的替代成像方法，可用于肾功能不全的此类患者群体中的常规非对比增强血管成像。本研究的目的是报告 s-CTA 在患有严重肢体缺血和肾功能不全的患者中的初步经验，涉及安全性、可行性和诊断准确性。
10 例非连续的缺血性足部溃疡患者进行了一条腿的 s-CTA。记录与程序相关的并发症，将影像学结果与常规数字减影血管造影（DSA）进行比较。
使用中位数 17 mL（范围 10-19 mL）的造影剂（400 mg I/mL）。中位数基线血浆肌酐在 s-CTA 前为 163 μmol/L（范围 105-569），在 s-CTA 后为 153 μmol/L（范围 105-562）（p =.24）。无穿刺部位并发症。在选择进行介入治疗的患者中（n = 6 例，30 个动脉节段），s-CTA 结果与 DSA 结果相关性良好；诊断灵敏度为 100%，特异性为 89%，准确性为 93%。
在这项初步研究中，提出了一种新的成像方法（s-CTA），它使用超低剂量碘造影剂提供高质量的动脉期图像，对于因肾功能不全而不适合常规对比增强成像方法的患者也很有用。
